Provider Demographics
NPI:1558895672
Name:SHROFF, NUPOOR
Entity Type:Individual
Prefix:
First Name:NUPOOR
Middle Name:
Last Name:SHROFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 MAIN ST
Mailing Address - Street 2:UNIT 111
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2198
Mailing Address - Country:US
Mailing Address - Phone:309-989-7107
Mailing Address - Fax:
Practice Address - Street 1:2 RECTOR ST
Practice Address - Street 2:1303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1819
Practice Address - Country:US
Practice Address - Phone:212-374-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039754-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist